Adding Finerenone to GLP-1 and SGLT2 Therapy Cuts Kidney Protein Leakage by Half in Diabetic Kidney Disease | Research

The takeaway

In patients with type 2 diabetes and chronic kidney disease already taking SGLT2 inhibitors and GLP-1 receptor agonists, adding finerenone reduced urinary albumin leakage by about 51% over six months in a real-world setting.

51.3% reduction in albuminuria
Patients already on GLP-1 receptor agonists and SGLT2 inhibitors achieved a further 51.3% reduction in urinary albumin when finerenone was added, over approximately six months.

What the researchers found

Over a median follow-up of 27 weeks, adding finerenone to existing SGLT2 inhibitor and GLP-1 receptor agonist therapy produced an adjusted 51.3% reduction in urinary albumin-to-creatinine ratio (UACR), a key marker of kidney damage.

Kidney function (eGFR) remained stable during the treatment period. Serum potassium levels did not rise to dangerous levels. The albuminuria reduction was consistent across subgroups analyzed by age, sex, BMI, baseline eGFR, and baseline UACR.

Notably, 94% of patients were also receiving a renin-angiotensin system inhibitor, meaning this was effectively a quadruple-therapy approach targeting multiple pathways of diabetic kidney disease.

Why it matters

Diabetic kidney disease is the leading cause of kidney failure worldwide. While individual medications like GLP-1 receptor agonists and SGLT2 inhibitors each provide kidney protection, this study demonstrates that stacking finerenone on top of these peptide-based and other therapies produces substantial additional benefit in real-world practice — not just in controlled clinical trials.

How the study worked

Retrospective cohort study from diabetes, endocrinology, and nephrology clinics at Maccabi Healthcare Services in Haifa, Israel. Included 51 adults with type 2 diabetes and chronic kidney disease (eGFR 25-60, UACR >300 mg/g) who had been on SGLT2 inhibitors and GLP-1 receptor agonists for at least 12 weeks before starting finerenone between August 2023 and January 2025. Outcomes were assessed at the last measurement within 26 ± 10 weeks of finerenone initiation. Multiple linear regression models were used, with prespecified subgroup analyses.

What this study cannot tell us

Small sample size of only 51 patients from a single healthcare system in Israel limits generalizability. The retrospective design cannot establish causation. Some outcome data appears truncated in the abstract (p-values cut off). There was no control group of patients not receiving finerenone. The relatively short follow-up of ~6 months cannot assess long-term kidney outcomes like progression to dialysis. Selection bias is possible as these were patients already on optimal triple therapy.

How to read the evidence

This is a small retrospective cohort study (n=51) without a control group, which limits causal inference. However, it provides valuable real-world evidence supporting findings from larger randomized controlled trials, showing the triple-therapy approach works outside of clinical trial settings.

When this study was published

Published in 2025, this is a very current study reflecting the latest clinical practice patterns in diabetic kidney disease management with recently approved therapies.

The bigger picture

The treatment of diabetic kidney disease has evolved rapidly with the approval of GLP-1 receptor agonists, SGLT2 inhibitors, and most recently finerenone. Clinical trials have shown each drug class provides independent kidney protection. This real-world study adds practical evidence that combining all three — a peptide-based GLP-1 RA, an SGLT2 inhibitor, and finerenone — is both effective and well-tolerated, supporting the emerging paradigm of multi-pathway kidney protection in diabetes.

Questions still open

Does the 51% albuminuria reduction with this triple-therapy approach translate into fewer patients progressing to kidney failure over the long term?
Would certain GLP-1 receptor agonists (semaglutide vs. liraglutide vs. dulaglutide) perform differently in this combination?
Is there a subset of patients who don't benefit from adding finerenone to existing SGLT2i + GLP-1 RA therapy?

Common questions

What does it mean to reduce albuminuria by 51%?

Albuminuria is the presence of a protein called albumin in urine, which signals kidney damage. Healthy kidneys filter albumin back into the blood, but damaged kidneys let it leak through. A 51% reduction means the amount of albumin leaking into urine was cut roughly in half, indicating the kidneys were better retaining protein — a sign of improved kidney health and reduced disease progression risk.

Why combine three different medications for diabetic kidney disease?

Each drug class protects the kidneys through a different mechanism: GLP-1 receptor agonists (peptide drugs) reduce inflammation and improve blood sugar control, SGLT2 inhibitors reduce pressure inside the kidney's filtering units, and finerenone blocks a hormone pathway that causes scarring and inflammation. By targeting multiple pathways simultaneously, the combination provides more comprehensive kidney protection than any single drug alone.

Read the original research

Real-World Effectiveness of Finerenone Added to SGLT2 Inhibitor and GLP-1 Receptor Agonist Therapy in Individuals with Type 2 Diabetes and Chronic Kidney Disease.

Journal of clinical medicine, 14(22)

View on PubMed ↗Publisher’s paper ↗

Citation

Nakhleh, Afif; Khazim, Khaled; Shehadeh, Naim. (2025). Real-World Effectiveness of Finerenone Added to SGLT2 Inhibitor and GLP-1 Receptor Agonist Therapy in Individuals with Type 2 Diabetes and Chronic Kidney Disease.. Journal of clinical medicine, 14(22). https://doi.org/10.3390/jcm14228209